Advanced Urothelial Carcinoma MCQ Quiz for Oncology App
Question 1: Grading System for Papillary and Flat Non-invasive Urothelial Neoplasia
Which of the following is the recommended grading system of choice for papillary and flat non-invasive urothelial neoplasia according to current guidelines?
A) WHO (1973) System B) WHO (2004)/ISUP System C) AJCC TNM System D) Jewett-Strong-Marshall System
Answer: B) WHO (2004)/ISUP System
Explanation: The International Consultation on Urologic Disease-European Association of Urology (ICUD) recommends the WHO (2004)/ISUP System as the grading system of choice for papillary and flat non-invasive urothelial neoplasia. This system established uniform terminology, definitions, and criteria for papillary neoplasia, removing ambiguity of the previous WHO 1973 system and simplifying flat urothelial lesions with non-reactive atypia into dysplasia and carcinoma in situ (CIS) 1.
Question 2: Micropapillary Urothelial Carcinoma
Which histological features are key diagnostic criteria for micropapillary urothelial carcinoma?
A) Squamous differentiation and keratin pearls B) Glandular differentiation and mucin production C) Multiple nests in the same lacuna and epithelial ring forms D) Spindle cell morphology and sarcomatoid features
Answer: C) Multiple nests in the same lacuna and epithelial ring forms
Explanation: Micropapillary urothelial carcinoma has received much attention for refined criteria to increase diagnostic reproducibility. The key diagnostic features include 'multiple nests in the same lacuna' and 'epithelial ring forms' as identified by the ICUD recommendations 1. This variant is important to recognize as it often behaves more aggressively than conventional urothelial carcinoma.
Question 3: Management of Muscle-Invasive Bladder Cancer
A 62-year-old patient is diagnosed with T2N0M0 muscle-invasive bladder cancer. According to current guidelines, which of the following represents the standard treatment approach?
A) Radical cystectomy alone B) Radical cystectomy with pelvic lymphadenectomy C) Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy with pelvic lymphadenectomy D) Trimodal therapy (maximal TURBT, radiation therapy, and radiosensitizing chemotherapy)
Answer: C) Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy with pelvic lymphadenectomy
Explanation: The American College of Oncology recommends radical cystectomy with pelvic lymphadenectomy as the standard treatment for muscle-invasive bladder cancer (MIBC), including at least common, internal, external, and obturator lymph nodes. Additionally, neoadjuvant cisplatin-based chemotherapy (3-4 cycles) is recommended to improve survival 2. This approach has shown superior outcomes compared to surgery alone in multiple studies.
Question 4: Inverted Urothelial Neoplasia Classification
How should inverted urothelial neoplasia be classified according to current recommendations?
A) Using a separate classification system specific to inverted growth patterns B) Using the WHO (2004)/ISUP System criteria extrapolated to inverted neoplasia C) Using the WHO (1973) system exclusively for inverted lesions D) Inverted lesions cannot be reliably classified and should be labeled as "atypical"
Answer: B) Using the WHO (2004)/ISUP System criteria extrapolated to inverted neoplasia
Explanation: The ICUD recommends that criteria used in the WHO/ISUP System can be extrapolated to inverted neoplasia, which are classified as inverted papilloma; inverted PUNLMP; inverted urothelial carcinoma, low-grade, non-invasive; inverted urothelial carcinoma, high-grade, non-invasive; or inverted urothelial carcinoma, high-grade, invasive 1. This standardized approach helps ensure consistent diagnosis and management of these lesions.
Question 5: Upper Tract vs. Bladder Urothelial Carcinoma
Which of the following statements accurately reflects the differences between upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BC)?
A) Gender has a similar prognostic impact in both UTUC and BC B) Staging accuracy is equivalent between UTUC and BC due to similar sampling techniques C) Intracavitary therapy guidelines are well-established for both UTUC and BC D) Technical limitations of upper tract sampling compared to transurethral resection for bladder cancer represent the most important source of staging differences
Answer: D) Technical limitations of upper tract sampling compared to transurethral resection for bladder cancer represent the most important source of staging differences
Explanation: While urothelial carcinoma of the bladder and upper tract share many characteristics, they represent distinct diseases. Technical limitations of upper tract urothelial carcinoma sampling compared to transurethral resection for urothelial carcinoma of the bladder are the most important source of staging differences between the two diseases 3. Additionally, women with bladder cancer present with worse tumor characteristics and survival than men, but gender does not appear to affect outcomes in UTUC.
Question 6: Systemic Therapy for Advanced Urothelial Carcinoma
In a patient with locally advanced or metastatic urothelial carcinoma who has progressed during or following platinum-containing chemotherapy, which of the following therapies is FDA-approved?
A) Pembrolizumab as a single agent B) Combination of pembrolizumab and axitinib C) Combination of pembrolizumab and lenvatinib D) Pembrolizumab with pemetrexed and platinum chemotherapy
Answer: A) Pembrolizumab as a single agent
Explanation: According to the FDA label, pembrolizumab (KEYTRUDA) is approved as a single agent for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy 4. Additionally, pembrolizumab is approved in combination with enfortumab vedotin for locally advanced or metastatic urothelial cancer.
Question 7: Grading of Invasive Urothelial Carcinoma
According to current guidelines, how should invasive urothelial carcinoma be graded?
A) Always as low-grade if invasion is limited to lamina propria B) Generally as high-grade, irrespective of the depth of invasion C) Using a three-tier system (grade I, II, III) based on nuclear features D) Based solely on the depth of invasion (T stage)
Answer: B) Generally as high-grade, irrespective of the depth of invasion
Explanation: The ICUD recommends that invasive urothelial carcinoma should generally be graded as high-grade, irrespective of the depth of invasion. However, recognizing that this issue is not completely resolved, invasive tumors may be further graded as required by institutional or clinical trial protocols 1. This approach acknowledges the inherently aggressive nature of invasive disease while allowing flexibility for specific research or institutional protocols.
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Advanced Urothelial Carcinoma MCQ Quiz
Question 1: Grading System for Papillary and Flat Non-invasive Urothelial Neoplasia
Which of the following is the recommended grading system of choice for papillary and flat non-invasive urothelial neoplasia according to current guidelines?
A) WHO (1973) System B) WHO (2004)/ISUP System C) AJCC TNM System D) Jewett-Strong-Marshall System
Answer: B) WHO (2004)/ISUP System
Explanation: The International Consultation on Urologic Disease-European Association of Urology (ICUD) recommends the WHO (2004)/ISUP System as the grading system of choice for papillary and flat non-invasive urothelial neoplasia. This system established uniform terminology, definitions, and criteria for papillary neoplasia, removing ambiguity of the previous WHO 1973 system and simplifying flat urothelial lesions with non-reactive atypia into dysplasia and carcinoma in situ (CIS) 1.
Question 2: Micropapillary Urothelial Carcinoma
Which histological features are key diagnostic criteria for micropapillary urothelial carcinoma?
A) Squamous differentiation and keratin pearls B) Glandular differentiation and mucin production C) Multiple nests in the same lacuna and epithelial ring forms D) Spindle cell morphology and sarcomatoid features
Answer: C) Multiple nests in the same lacuna and epithelial ring forms
Explanation: Micropapillary urothelial carcinoma has received much attention for refined criteria to increase diagnostic reproducibility. The key diagnostic features include 'multiple nests in the same lacuna' and 'epithelial ring forms' as identified by the ICUD recommendations 1. This variant is important to recognize as it often behaves more aggressively than conventional urothelial carcinoma.
Question 3: Management of Muscle-Invasive Bladder Cancer
A 62-year-old patient is diagnosed with T2N0M0 muscle-invasive bladder cancer. According to current guidelines, which of the following represents the standard treatment approach?
A) Radical cystectomy alone B) Radical cystectomy with pelvic lymphadenectomy C) Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy with pelvic lymphadenectomy D) Trimodal therapy (maximal TURBT, radiation therapy, and radiosensitizing chemotherapy)
Answer: C) Neoadjuvant cisplatin-based chemotherapy followed by radical cystectomy with pelvic lymphadenectomy
Explanation: The American College of Oncology recommends radical cystectomy with pelvic lymphadenectomy as the standard treatment for muscle-invasive bladder cancer (MIBC), including at least common, internal, external, and obturator lymph nodes. Additionally, neoadjuvant cisplatin-based chemotherapy (3-4 cycles) is recommended to improve survival 2. This approach has shown superior outcomes compared to surgery alone in multiple studies.
Question 4: Inverted Urothelial Neoplasia Classification
How should inverted urothelial neoplasia be classified according to current recommendations?
A) Using a separate classification system specific to inverted growth patterns B) Using the WHO (2004)/ISUP System criteria extrapolated to inverted neoplasia C) Using the WHO (1973) system exclusively for inverted lesions D) Inverted lesions cannot be reliably classified and should be labeled as "atypical"
Answer: B) Using the WHO (2004)/ISUP System criteria extrapolated to inverted neoplasia
Explanation: The ICUD recommends that criteria used in the WHO/ISUP System can be extrapolated to inverted neoplasia, which are classified as inverted papilloma; inverted PUNLMP; inverted urothelial carcinoma, low-grade, non-invasive; inverted urothelial carcinoma, high-grade, non-invasive; or inverted urothelial carcinoma, high-grade, invasive 1. This standardized approach helps ensure consistent diagnosis and management of these lesions.
Question 5: Upper Tract vs. Bladder Urothelial Carcinoma
Which of the following statements accurately reflects the differences between upper tract urothelial carcinoma (UTUC) and bladder urothelial carcinoma (BC)?
A) Gender has a similar prognostic impact in both UTUC and BC B) Staging accuracy is equivalent between UTUC and BC due to similar sampling techniques C) Intracavitary therapy guidelines are well-established for both UTUC and BC D) Technical limitations of upper tract sampling compared to transurethral resection for bladder cancer represent the most important source of staging differences
Answer: D) Technical limitations of upper tract sampling compared to transurethral resection for bladder cancer represent the most important source of staging differences
Explanation: While urothelial carcinoma of the bladder and upper tract share many characteristics, they represent distinct diseases. Technical limitations of upper tract urothelial carcinoma sampling compared to transurethral resection for urothelial carcinoma of the bladder are the most important source of staging differences between the two diseases 3. Additionally, women with bladder cancer present with worse tumor characteristics and survival than men, but gender does not appear to affect outcomes in UTUC.
Question 6: Systemic Therapy for Advanced Urothelial Carcinoma
In a patient with locally advanced or metastatic urothelial carcinoma who has progressed during or following platinum-containing chemotherapy, which of the following therapies is FDA-approved?
A) Pembrolizumab as a single agent B) Combination of pembrolizumab and axitinib C) Combination of pembrolizumab and lenvatinib D) Pembrolizumab with pemetrexed and platinum chemotherapy
Answer: A) Pembrolizumab as a single agent
Explanation: According to the FDA label, pembrolizumab (KEYTRUDA) is approved as a single agent for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy 4. Additionally, pembrolizumab is approved in combination with enfortumab vedotin for locally advanced or metastatic urothelial cancer.
Question 7: Grading of Invasive Urothelial Carcinoma
According to current guidelines, how should invasive urothelial carcinoma be graded?
A) Always as low-grade if invasion is limited to lamina propria B) Generally as high-grade, irrespective of the depth of invasion C) Using a three-tier system (grade I, II, III) based on nuclear features D) Based solely on the depth of invasion (T stage)
Answer: B) Generally as high-grade, irrespective of the depth of invasion
Explanation: The ICUD recommends that invasive urothelial carcinoma should generally be graded as high-grade, irrespective of the depth of invasion. However, recognizing that this issue is not completely resolved, invasive tumors may be further graded as required by institutional or clinical trial protocols 1. This approach acknowledges the inherently aggressive nature of invasive disease while allowing flexibility for specific research or institutional protocols.